Characteristics of anemia and iron status and their ... · Objective (1) prevalence of anemia and...
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References Conclusions 1) Investigate the prevalence, types, and severity of childhood anemia and iron status by study nation, age, and gender 2) Examine protective and risk factors associated with anemia and ID 3) Study and document the possible associations between blood Mn, Zn, Co, Cd, Pb and iron biomarkers, considering relevant co-variables Results Study design Introduction • Canada is among countries with the lowest prevalence of anemia (3%). • This prevalence is invariably higher among its First Nations, particularly children 1 . • Childhood anemia is associated with growth, developmental, cognitive, psychomotor and immune system impairments. • In First Nations communities, iron and other micronutrients deficiencies, infections and lead exposure are frequent, and possibly risk factors for iron deficiency (ID) and anemia 2 . • Higher intake of animal proteins (rich in bioavailable heme- iron), vitamin C (non-heme iron absorption enhancer), fruits and vegetables (rich in vitamins) are considered protective factors against ID and anemia 2 . • Divalent metals − manganese (Mn), zinc (Zn), cobalt (Co), cadmium (Cd) and lead (Pb) − interact with iron at different levels in human body 3 . • ID may upregulates the absorption and concentration of these metals inside human body, possibly increasing their toxicities 3. • The study Youth Environment Study (YEH) was conducted among four First Nation communities in Quebec in Québec, Canada (see Figure 1) • Two Anishinabe communities (Abitibi-Temiscamingue region) • Two Innu communities (North Shore region) • Transversal study conducted in May-June and Sept- Oct 2015, with 198 participants aged 3 to 19 years • Data collected relevant for the present project: • Anthropometric measurements • Blood samples: Hemoglobin (Hb) (in situ), inflammatory biomarker (hs-CRP), and iron, Mn, Cd, Pb, Zn, Co biomarkers • Individual questionnaires: • Socio-demographic • Food security & lifestyle • Food Frequency Questionnaires (FFQ) (traditional food & market foods) • Intakes calculated based on FFQ and food composition data Figure 1: Studied First Nations and communities Objective (1) prevalence of anemia and ID Descriptive statistics types of anemia and ID Objective (2) risk factors for anemia and ID Structural Equation Modeling Objective (3) associations Mn, Zn, Co, Cd, Pb and iron Multiple regression analysis for Iron biomarkers and Mn, Zn, Co, Cd and Pb Figure 2 :Statistical analysis 1. Government of Canada. (2016). Quebec Indigenous Community profiles. Retrieved March 13, 2017 2. Couture, A., Levesque, B., Dewailly, É., Muckle, G., Déry, S., & Proulx, J.-F. (2012). Lead exposure in Nunavik: from research to action. International Journal of Circumpolar Health, 71, 18591. 3. Aschner, J. L., & Aschner, M. (2005). Nutritional aspects of manganese homeostasis. Molecular Aspects of Medicine, 26, 353–362. 4. Roth, J. A., & Garrick, M. D. (2003). Iron interactions and other biological reactions mediating the physiological and toxic actions of manganese. Biochemical Pharmacology, 66(1), 1–13. 5. WHO. (2001). Iron Deficiency Anaemia: Assessment, Prevention and Control, A guide for program managers. A guide for programme mangers. 6. Cooper, M., Greene-Finestone, L., Lowell, H., Levesque, J., & Robinson, S. (2012). Iron sufficiency of Canadians. Health Reports / Statistics Canada, Canadian Centre for Health Information • Thanks extended to study participants, their parents and project partners Study funded by: • ID and anemia are considerably higher than CHMS and comparable in both studied nations • ID is particularly high among 12-19 years old girls • According to OMS : anemia is a moderate public health problem among 6-11 years old boys and 12-19 years old girls • Higher intake of powder juice (fortified with vitamin C) and related vitamin C intake (an iron absorption enhancer) is associated with lower ID and anemia • High blood Mn concentrations is similar between nations and no environmental sources were identified • Low blood Pb concentrations • Blood Mn and Co concentrations correlates negatively with iron stores • These preliminary findings suggest that increasing intake of vitamin C (from other sources than power juice which are excessively elevated in added sugar) would prevent ID, anemia and blood manganese excess Acknowledgements Characteristics of anemia and iron status and their associations with blood manganese and lead among children aged 3 to 19 years old from four First Nation communities in Québec Emad Tahir 1,2 , Pierre Ayotte 1,2,3 , Matthew Little 1,2 , Richard E. Bélanger 1, 4 , Michel Lucas 1, 2 , Donna Mergler 5 , Elhadji A. Laouan Sidi 2 , Community of Winneway – Long Point First Nation, Community of Lac Simon, CSSS Tshukuminu Kanani of Nutashkuan, Community of Unamen Shipu, Nancy Gros-Louis McHugh 6 , Mélanie Lemire 1,2 1 Nasivvik Research Chair in Ecosystem Approaches to Northern Health, Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec – Université Laval; 2 Département de médecine sociale et préventive, Université Laval, Québec, QC, Canada; 3 Institut national de santé publique du Québec, Québec, QC, Canada; 4 Département de pédiatrie, Université Laval, Québec, QC, Canada; 5 CINBIOSE, Université du Québec à Montréal, Montréal, QC, Canada; 6 First Nation of Québec and Labrador Health and Social Services Commission, Wendake, QC, Canada Study objectives Figure 4: Proportions of ID by age groups: YEH vs Canadian Health Measures Survey (CHMS) Figure 5: Proportions of anemia by age groups: YEH vs CHMS Red lines refer to WHO reference values for public health significance of anemia 5,6 Please note that CHMS coding for ID and anemia is slightly different than in the YEH project Figure 3: Prevalence of anemia, anemia subtypes and ID by nation Table 2: Results of the structural equation modeling/factorial analysis for protective and risk factors for Hb and ferritin Models are adjusted for age, sex, nation, education, household, interviewer, inflammatory biomarker, manganese ,iron , zinc and vitamin c intake, BMI, and sources of drinking water. Figure 6: Significant associations between blood Mn, Co and serum ferritin concentrations (iron stores ) Results are presented for193 participants, 5 participants were excluded due of missing data • Higher intake of powder juice (fortified with vitamin C) and related vitamin C intake (an iron absorption enhancer) is associated with lower ID and anemia • Models are controlled for household, age, sex , nation, interviewer and body mass index (BMI) and socioeconomic status Factor Standardized estimates for Hb (95%CI) Standardized estimates for ferritin (95%CI) Vegetables and fruits 0.13 (-0.38, 0.52) 0.13 (-0.16, 0.44) Powder juice → vitamin C 0.15 (0.004, 0.16)* 0.15 (0.02, 0.27)* Inflammatory markers - 0.1 (-0.23, 0.04) 0.12 (0.04, 0.18)* Traditional meat 0.07 (-0.17, 0.32) 0.03 (-0.29, 0.36) Market meat 0.02 (- 0.34, 0.37) - 0.02 (-0.62, 0.59) Table 3: Divalent metals in YEH by nation and compared to CHMS • Exclusion of 3 participants based on liver diseases or dysfunctions • Blood Mn is higher and blood Pb is lower than in CHMS (Cycle 2 or 3) (3-19 yrs old) Manganese (Mn) Zinc (Zn) Cobalt (Co) Cadmium (Cd) Lead (Pb) Essential trace element and cofactor for many enzymes Essential trace element, cofactor for many enzymes Essential trace element entre in vitamin B12 synthesis Xenobiotic Xenobiotic Food, airborne, water, mining activities Food, mining activities, steel smelting Food, airborne due to metal smelting Smoking, water ingestion, battery disposal Old residential paints, hunting activities Neurobehavioral, memory and movement problem Hematological, gastrointestinal effects, immunotoxic Possibly carcinogenic to human Chronic exposure carcinogenic Attention, IQ, hematological & neurobehavioral Table1: Divalent metals profile Contact: [email protected] > 20% Moderate public health problem > 5% Mild public health problem Anishinabe N=112 Role Source of exposure Health effects Metal Anishinabe (n=106) Geo mean (range) Innu (n=84) Geo mean (range) Blood Mn (µg/L ) 15.33 (11.83, 18.83) 16.17 (12.71, 19.63) Plasma Zn (µg/L ) 1134.34 (980.38, 1288.30) 1081.87 (935.09, 1228.66) Blood Co (µg/L ) 0.26 (0.19, 0.33)* 0.18 (0.12, 0.25) Blood Cd (µg/L ) 0.51 (0.43, 0.58) 0.48 (0.40, 0.56) Blood Pb (µg/L ) 5.35 (3.51, 7.65) 7.21 (5.07, 9.87)* Figure 7: Insignificant associations between blood Cd, Zn, Pb and serum ferritin concentrations (iron stores ) * : significant association for combined direct and indirect effects (p < 0.05) * : significant difference between nation (T-test, p < 0.05)
Transcript of Characteristics of anemia and iron status and their ... · Objective (1) prevalence of anemia and...
References
Conclusions
1) Investigate the prevalence, types, and severity ofchildhood anemia and iron status by study nation, age,and gender
2) Examine protective and risk factors associated withanemia and ID
3) Study and document the possible associations betweenblood Mn, Zn, Co, Cd, Pb and iron biomarkers,considering relevant co-variables
Results
Study design
Introduction• Canada is among countries with the lowest prevalence ofanemia (3%).• This prevalence is invariably higher among its First Nations,particularly children1.• Childhood anemia is associated with growth, developmental,cognitive, psychomotor and immune system impairments.• In First Nations communities, iron and other micronutrientsdeficiencies, infections and lead exposure are frequent, andpossibly risk factors for iron deficiency (ID) and anemia2.• Higher intake of animal proteins (rich in bioavailable heme-iron), vitamin C (non-heme iron absorption enhancer), fruitsand vegetables (rich in vitamins) are considered protectivefactors against ID and anemia2.• Divalent metals − manganese (Mn), zinc (Zn), cobalt (Co), cadmium (Cd) and lead (Pb) − interact with iron at differentlevels in human body3.• ID may upregulates the absorption and concentration ofthese metals inside human body, possibly increasing theirtoxicities3.
• The study Youth Environment Study (YEH) wasconducted among four First Nation communities inQuebec in Québec, Canada (see Figure 1)• Two Anishinabe communities (Abitibi-Temiscamingue region)• Two Innu communities (North Shore region)
• Transversal study conducted in May-June and Sept-Oct 2015, with 198 participants aged 3 to 19 years
• Data collected relevant for the present project:• Anthropometric measurements• Blood samples: Hemoglobin (Hb) (in situ), inflammatory
biomarker (hs-CRP), and iron, Mn, Cd, Pb, Zn, Co biomarkers• Individual questionnaires:
• Socio-demographic• Food security & lifestyle• Food Frequency Questionnaires (FFQ) (traditional food & market
foods)• Intakes calculated based on FFQ and food composition data
Figure1:StudiedFirstNationsandcommunities
Objective(1)prevalenceofanemiaandID
DescriptivestatisticstypesofanemiaandID
Objective(2)riskfactorsforanemiaandID
StructuralEquationModeling
Objective(3)associations
Mn,Zn,Co,Cd,Pbandiron
MultipleregressionanalysisforIronbiomarkersandMn,Zn,Co,CdandPb
Figure2:Statisticalanalysis
1. GovernmentofCanada.(2016).QuebecIndigenousCommunityprofiles.RetrievedMarch13,20172. Couture,A.,Levesque,B.,Dewailly,É.,Muckle,G.,Déry,S.,&Proulx,J.-F.(2012).LeadexposureinNunavik:fromresearchtoaction.International
JournalofCircumpolarHealth,71,18591.3. Aschner,J.L.,&Aschner,M.(2005).Nutritionalaspectsofmanganesehomeostasis.MolecularAspectsofMedicine,26,353–362.4. Roth,J.A.,&Garrick,M.D.(2003).Ironinteractionsandotherbiologicalreactionsmediatingthephysiologicalandtoxicactionsofmanganese.
BiochemicalPharmacology,66(1),1–13.5. WHO.(2001).IronDeficiencyAnaemia:Assessment,PreventionandControl,Aguideforprogrammanagers.Aguideforprogramme mangers.6. Cooper,M.,Greene-Finestone,L.,Lowell,H.,Levesque,J.,&Robinson,S.(2012).IronsufficiencyofCanadians.HealthReports/StatisticsCanada,
CanadianCentreforHealthInformation
• Thanksextendedtostudyparticipants,theirparentsandprojectpartners
Studyfundedby:
• IDandanemiaareconsiderablyhigherthanCHMSandcomparableinbothstudiednations• IDisparticularlyhighamong12-19yearsoldgirls• AccordingtoOMS:anemiaisamoderatepublichealthproblem
among6-11yearsoldboysand12-19yearsoldgirls• Higherintakeofpowderjuice(fortifiedwithvitamin
C)andrelatedvitaminCintake(anironabsorptionenhancer)isassociatedwithlowerIDandanemia
• HighbloodMn concentrationsissimilarbetweennationsandnoenvironmentalsources wereidentified
• LowbloodPb concentrations• BloodMn andCoconcentrationscorrelatesnegatively
withironstores• Thesepreliminaryfindingssuggestthatincreasing
intakeofvitaminC(fromothersourcesthanpowerjuicewhichareexcessivelyelevatedinaddedsugar)wouldpreventID,anemiaandbloodmanganeseexcessAcknowledgements
Characteristics of anemia and iron status and their associations with blood manganese and lead among children aged 3 to 19 years old from four First Nation communities in Québec
EmadTahir1,2,PierreAyotte1,2,3,MatthewLittle1,2,RichardE.Bélanger1,4,MichelLucas1,2,DonnaMergler5,ElhadjiA.LaouanSidi2,CommunityofWinneway– LongPointFirstNation,CommunityofLacSimon,CSSSTshukuminuKananiofNutashkuan,CommunityofUnamenShipu,NancyGros-LouisMcHugh6,MélanieLemire1,2
1NasivvikResearchChairinEcosystemApproachestoNorthernHealth,Axesantédespopulationsetpratiquesoptimalesensanté,CentrederechercheduCHUdeQuébec– UniversitéLaval;2Départementdemédecinesocialeetpréventive,UniversitéLaval,Québec,QC,Canada;3InstitutnationaldesantépubliqueduQuébec,Québec,QC,Canada;4Départementdepédiatrie,UniversitéLaval,Québec,QC,Canada;5CINBIOSE,UniversitéduQuébecàMontréal,Montréal,QC,Canada;6FirstNationofQuébecand
LabradorHealthandSocialServicesCommission,Wendake,QC,Canada
Study objectives
Figure4:ProportionsofIDbyagegroups:YEHvsCanadianHealthMeasuresSurvey(CHMS)
Figure5:Proportionsofanemiabyagegroups:YEHvsCHMS
RedlinesrefertoWHOreferencevaluesforpublichealthsignificanceofanemia 5,6
PleasenotethatCHMScodingforIDandanemiaisslightlydifferentthanintheYEHproject
Figure3:Prevalenceofanemia,anemiasubtypesandIDbynation
Table2:Resultsofthestructuralequationmodeling/factorialanalysisforprotective
andriskfactorsforHbandferritin
Modelsareadjustedforage,sex,nation,education,household,interviewer,inflammatorybiomarker,manganese ,iron,zincandvitamincintake,BMI,andsourcesofdrinkingwater.
Figure6:SignificantassociationsbetweenbloodMn,Coandserumferritinconcentrations(ironstores)
Resultsarepresentedfor193participants,5participantswereexcludeddueofmissingdata
• Higherintakeofpowderjuice(fortifiedwithvitaminC)andrelatedvitaminCintake(anironabsorptionenhancer)isassociatedwithlowerIDandanemia
• Modelsarecontrolledforhousehold,age,sex,nation,interviewerandbodymassindex(BMI)andsocioeconomicstatus
FactorStandardizedestimatesfor
Hb(95%CI)Standardizedestimatesfor
ferritin(95%CI)
Vegetablesandfruits 0.13(-0.38,0.52) 0.13(-0.16,0.44)
Powderjuice→vitaminC 0.15(0.004,0.16)* 0.15(0.02,0.27)*
Inflammatorymarkers - 0.1(-0.23,0.04) 0.12(0.04,0.18)*
Traditionalmeat 0.07(-0.17,0.32) 0.03(-0.29,0.36)
Marketmeat 0.02(- 0.34,0.37) - 0.02(-0.62,0.59)
Table3:DivalentmetalsinYEHbynationandcomparedtoCHMS
• Exclusionof3participantsbasedonliverdiseasesordysfunctions• BloodMnishigherandbloodPbislowerthaninCHMS(Cycle2or3)(3-19yrs old)
Manganese(Mn) Zinc(Zn) Cobalt(Co) Cadmium(Cd) Lead(Pb)
Essentialtraceelementandcofactorformanyenzymes
Essentialtraceelement,cofactorformanyenzymes
EssentialtraceelemententreinvitaminB12synthesis
Xenobiotic Xenobiotic
Food,airborne,water,miningactivities
Food,miningactivities,steelsmelting
Food,airborneduetometalsmelting
Smoking,wateringestion,batterydisposal
Oldresidentialpaints,huntingactivities
Neurobehavioral,memoryandmovementproblem
Hematological,gastrointestinaleffects,immunotoxic
Possiblycarcinogenictohuman
Chronicexposurecarcinogenic
Attention,IQ,hematological&neurobehavioral
Table1:Divalentmetalsprofile
Contact:[email protected]
>20%Moderatepublichealthproblem
>5%Mildpublichealthproblem
Anishinabe N=112
Role
Sourceof
expo
sure
Health
effects
MetalAnishinabe(n=106)Geo mean (range)
Innu(n=84)Geo mean (range)
BloodMn(µg/L ) 15.33(11.83,18.83) 16.17(12.71,19.63)
PlasmaZn(µg/L ) 1134.34(980.38,1288.30) 1081.87(935.09,1228.66)
BloodCo(µg/L ) 0.26(0.19,0.33)* 0.18(0.12,0.25)
BloodCd(µg/L ) 0.51(0.43,0.58) 0.48(0.40,0.56)
BloodPb(µg/L ) 5.35(3.51,7.65) 7.21(5.07,9.87)*
Figure7:InsignificantassociationsbetweenbloodCd,Zn,Pbandserumferritinconcentrations(ironstores)
*:significantassociationforcombineddirectandindirecteffects(p<0.05)
*:significantdifferencebetweennation(T-test,p<0.05)
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